The Nook Clinic, led by Dr Selina Warlow, is raising urgent awareness of an oftenoverlooked issue: masking, the effort to conceal symptoms of autism and also ADHD, especially among older adults, particularly women and girls.
Though masking may serve as an adaptive strategy, it exacts a heavy toll on mental health and identity. By copying social behaviours and suppressing natural traits, is leaving many exhausted, misdiagnosed, and struggling in silence.
“What we’re seeing, particularly in girls, women and older adults, are those who have survived by masking their true selves, at the expense of their health and well-being. Masking should not be a silent survival strategy; people deserve to live authentically, with the right support and understanding,” said Dr Warlow.
What Is Masking?
Masking (also called camouflaging) involves suppressing neurodivergent traits in order to appear “neurotypical.” This may include forcing eye contact, mimicking others’ social cues, scripting conversations, or suppressing stimming (self-soothing behaviours).
While it can help people “fit in,” research shows it comes at a high cost to mental health, identity, and long-term well-being (National Autistic Society, Molecular Autism, 2021).
Women: Masking Leads to Missed Diagnoses
Autistic women and girls are far more likely to mask than men, often due to cultural and social expectations. This means traits go unnoticed or misinterpreted, and diagnoses are frequently delayed by years, sometimes decades (National Autistic Society).
• Women often become adept at scripting conversations, mirroring social behaviours, and hiding sensory discomfort.
• This “invisibility” leads to misdiagnosis as anxiety, depression, or personality disorders.
• The emotional toll: exhaustion, burnout, and fractured self-identity
Older Adults: Decades of Masking Without Support
A UK review published in August 2025 revealed that up to 90% of autistic people over 50 are undiagnosed or misdiagnosed (The Guardian). Many have lived entire adult lives masking without recognition or support.
• Masking in older adults often begins in childhood and becomes second nature.
• The lack of diagnosis means individuals miss out on adjustments, validation, and community.
• Over time, the psychological strain contributes to poorer mental and physical health compared with non-autistic peers.
The Impact: Burnout, Mental Health Strain, Identity Erosion
Masking can lead to exhaustion, anxiety, depression and delayed diagnosis (autism.org.uk). It prevents authentic connection and can result in profound mental health challenges.
Supporting Neurodivergent People in the Here and Now
The Nook Clinic encourages communities, even workplaces, and families to take immediate steps to reduce the pressure of masking.
1. Normalise Difference: Accept varied communication styles (e.g. reduced eye contact, stimming) without judgment.
2. Provide Flexible Environments: Offer quiet spaces, remote working options, and flexible schedules where possible.
3. Encourage Authenticity: Make it clear that colleagues, clients, and family members don’t need to “perform” to be accepted.
4. Listen Without Assumptions: Believe people when they describe their challenges, even if they appear outwardly “high functioning.”
5. Peer & Professional Support; Encourage support groups, therapy and coaching tailored for late-diagnosed adults.
6. Promote Education: Train teams and managers to recognise masking behaviours and support inclusivity at every level.
